Staff retention in healthcare is certainly getting tougher, as evidenced by one Wisconsin hospital's to sue a group of healthcare workers to keep them from leaving the facility. The lawsuit didn't work due to a judge's order barring the hospital's attempt, but can you blame the hospital for trying?
Yes, I can, because even if it did work, those would be highly de-motivated employees, and they would create a toxic environment among all the employees at the hospital.
The shows a hospital staff turnover rate greater than 19% in 2020. With "The Great Resignation" continuing to ripple out from COVID-19, turnover is likely with us for a while.
Lack of money is a de-motivator, but money does not motivate, according to the by psychologist Frederick Herzberg, PhD. In his research conducted in the 1950s and 1960s, Herzberg found that monetary compensation can only prevent dissatisfaction among workers; it doesn't make employees happier or more satisfied. Instead, the desire for achievement motivates more than material rewards such as cash.
Of course, employees like cash, with in one study ranking pay as the top factor in job satisfaction. But it is not the end-all. One study of healthcare workers found that more than half said being among colleagues they enjoy and being allowed to be themselves was the number one factor in staying in their positions for a long time.
In my four decades practicing medicine, I have found staff motivation to be the most important pillar of a successful practice. Patients interact with a practice's staff four to five times longer than with the physician. Bad staff attitude can ruin a practice.
Here are seven methods I've used to enhance staff morale -- without pay increases. Some cost a little money, while others cost nothing but a little time and effort.
Develop and Promote a Bottom-Up Mission Statement
My practice's mission statement, created by the staff, states, "This office is committed to: 1) excellence, 2) the best healthcare for our patients, and 3) the persistent attention to the little details because we think they make a big difference." This pledge is displayed everywhere in our office, on our website, and as a screen saver on the EMR on each computer. Patients see the mission statement as soon as they enter the office because it tells them what they can expect from the staff, and it is a visible reminder to the staff of the high standards expected of them.
Conduct Regular Staff Meetings
There is no better way to bring staff together than to have creative staff meetings that produce positive changes in behavior, which translate to enhanced quality of care. These meetings should offer the staff plenty of opportunities to get involved in decision making, which can make them feel part of a valued team.
Pay Ample Public Recognition
"Psychic pay" is just as important as monetary rewards. As Napoleon said, "Give me enough ribbons to place on the tunics of my soldiers and I can conquer the world." My practice has ABCD awards or "Above and Beyond the Call of Duty."
When I or my office manager sees an employee doing something right, we bring it to everyone's attention. Employees value public acts of recognition. We also send a thank-you note to the employee's home. Often, we award the recipient with an "Extra Mile-O-Gram" or a "Thanks a Million Check."
It's easy to underestimate how appreciative -- and motivated -- employees are with public as well as private recognition.
Keep Surprising
An unexpected perk for staff members also generates often unexpected gratitude. For example, when two employees were absent for a week, we were still able to function at normal speed and capacity without affecting quality of care. I subsequently arranged for a massage therapist to give a 15-minute massage to any employee who wanted one at the end of the day on a Friday.
On another occasion, we closed the office for a long lunch and hired a limo to take the staff on a shopping trip to the mall, complete with a box lunch for everyone. Each staff member received $100 for a one-hour buying spree. The team reminisced fondly about that experience for years afterward.
Give Staff Bonuses for Money Savers and Expense Reductions
If a staffer suggests a workable idea that saves the practice money, pay him or her for the idea. For example, when our autoclave broke, a vendor said it wasn't repairable. That didn't stop one of the nurses from taking the machine to the hospital's biomedical engineering department, where a technician installed a $30 part that avoided purchase of a new $2,000 autoclave. She got a $100 bonus.
Turn the Tables and Serve Them
Take an employee out to lunch as a reward for excellent service or just to show they're appreciated by the doctor or office manager. Spending one-on-one time with an employee is a powerful motivator. This special time provides an opportunity to receive employee feedback on office issues. Here's a similar example from Paul Kurkjian, MD, a California neuropsychiatrist: every Friday he brings bagels, fruit, and coffee and serves his employees. He reports improved morale and productivity.
Free Time
Offering work flexibility is not easy in the medical profession. However, millennials are demanding it, and greatly appreciate a little discretionary time. Every now and then, the reward of an extra day or afternoon off with pay is a memorable gift and an effective motivator.
For hospitals still struggling with pandemic woes, retention has risen to an unprecedentedly high priority. An astonishing cite retention as a "key strategic imperative," given that one in 10 RN positions went vacant in 2021 and more than one-third of hospitals reported a vacancy rate greater than 10%.
Of course, we can and should strive to boost compensation for healthcare employees to competitive levels. However, the shortest road to success is not always paved with gold, but rather, is often marked with roadside signs of earnest gratitude from the boss.
Neil Baum, MD, is a physician in New Orleans, the corporate medical officer of , adjunct professor of the Tulane University School of Medicine, and the author of The Complete Guide to a Successful Medical Practice (Springer 2015).